Indirect Pathways from Early Adversity to Postpartum Depression after Assisted Reproduction: Attachment, Maternal Self-Efficacy, and Financial Strain

Backgrounds: Adverse childhood experiences (ACEs) can increase the likelihood of developing insecure attachment patterns, which in turn may heighten economic concerns and couple dissatisfaction—both generally and particularly in the context of assisted reproduction treatments (ART). These processes together elevate the risk of postpartum depression (PPD). Methods: This study examined psychosocial and relational predictors of PPD in a sample of 149 Spanish women up to 12 months postpartum following ART. (8.1% = artificial insemination with a sperm donor; 12.1% = artificial insemination without a sperm donor; 67.1% = in vitro fertilization; 20.8% = intracytoplasmic sperm injection; 12.8% = egg donation; 22.1% = frozen-thawed embryo transfer). Predictors included subdomains of ACEs (abuse and household dysfunction), maternal self-efficacy, romantic attachment (anxiety/avoidance), couple satisfaction (ad hoc item, 0–10), and financial concerns (ad hoc item, 0–10). Results: Hierarchical regression analyses showed that economic worry and low maternal self-efficacy accounted for 29% of the variance in PPD in the final step. Mediation models revealed that attachment anxiety partially mediated the association between childhood abuse and PPD. (β = 0.018, 95% CI [0.0002, 0.0396]), whereas avoidance did not emerge as a significant pathway. There was a lack of association between family dysfunction and attachment dimensions, which should be interpreted cautiously due to the subscale’s limited reliability in this sample. Furthermore, maternal self-efficacy partially mediated the link between financial concerns and PPD (β = 0.096, 95% CI [0.0003, 0.2533]), indicating that economic strain increases depressive symptoms partly by undermining maternal confidence. Conclusion: For women conceiving through ART, the relevance of maternal self-efficacy and socioeconomic stress are highlighted as key targets for prevention and intervention. The role of attachment anxiety is, as well, underscored as a mechanism linking early adversity to PPD.